Healthcare Provider Details

I. General information

NPI: 1558844050
Provider Name (Legal Business Name): JASMINE SANTOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E KINGS CANYON RD APT 104
FRESNO CA
93702-3604
US

IV. Provider business mailing address

4411 E KINGS CANYON RD APT 104
FRESNO CA
93702-3604
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-7180
  • Fax:
Mailing address:
  • Phone: 559-600-7180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95075309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: